Provider Demographics
NPI:1275307662
Name:BODY OF BEVERLY HILLS WELLNESS INC
Entity Type:Organization
Organization Name:BODY OF BEVERLY HILLS WELLNESS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:
Authorized Official - Last Name:REGENASS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-291-3636
Mailing Address - Street 1:17609 VENTURA BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5148
Mailing Address - Country:US
Mailing Address - Phone:818-291-3636
Mailing Address - Fax:877-395-9650
Practice Address - Street 1:17609 VENTURA BLVD STE 104
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5148
Practice Address - Country:US
Practice Address - Phone:818-291-3636
Practice Address - Fax:877-395-9650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-07
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty